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BACKGROUND: Socioeconomic status (SES) can greatly affect the clinical outcome of medical problems. We sought to assess the in-hospital mortality of patients with the acute coronary syndrome (ACS) according to their SES.

METHODS: All patients admitted to Tehran Heart Center due to 1(st)-time ACS between March 2004 and August 2011 were assessed. The patients who were illiterate/lowly educated (≤5 years attained education) and were unemployed were considered low-SES patients and those who were employed and had high educational levels (>5 years attained education) were regarded as high-SES patients. Demographic, clinical, paraclinical, and in-hospital medical progress data were recorded. Death during the course of hospitalization was considered the end point, and the impact of SES on in-hospital mortality was evaluated.

CONCLUSIONS: This study found that patients with low SES were at a higher risk of in-hospital mortality due to the ACS. Furthermore, the results suggest the need for increased availability of jobs as well as improved levels of education as preventive measures to curb the unfolding deaths owing to coronary artery syndrome.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden.

Diverse ethnic groups may differ regarding the risk factors and severity of coronary artery disease (CAD). This study sought to assess the association between ethnicity and CAD risk and severity in six major Iranian ethnic groups.

Methods

In this study, 20,165 documented coronary artery disease patients who underwent coronary angiography at a tertiary referral heart center were recruited. The demographic, laboratory, clinical, and risk factor data of all the patients were retrieved. The Gensini score (an indicator of CAD severity) was calculated for all, and the risk factors and severity of CAD were compared between the ethnical groups, using adjusted standardized residuals, Kruskal–Wallis test, and multivariable regression analysis.

Results

The mean age of the participants (14,131 [70.1%] men and 6034 [29.9%] women) was 60.7 ± 10.8 years. The Fars (8.7%) and Gilak (8.6%) ethnic groups had the highest prevalence of ≥4 simultaneous risk factors. The mean Gensini score was the highest for the Gilaks (77.1 ± 55.9) and the lowest among the Lors (67.5 ± 52.8). The multivariable regression analysis showed that the Gilaks had the worst severity (β 0.056, 95% CI 0.009 to 0.102; P = 0.018), followed by the Torks (β 0.032, 95% CI 0.005 to 0.059; P = 0.020). Meanwhile, the Lors showed the lowest severity (β −0.087, 95% CI −0.146 to −0.027; P = 0.004).

Conclusions

This study found that there was heterogeneity in CAD severity and a diverse distribution in its well-known traditional risk factors among major Iranian ethnic groups.

Background: Given gender differences in the risk of coronary artery disease (CAD), the present study sought to investigate these dissimilarities amongst patients who underwent angiography at a major, tertiary heart hospital in Iran. Methods: Between 2005 and 2010, 44,820 patients who underwent coronary angiography were enrolled in a registry. Pre-procedural data such as demographics, CAD risk factors, presenting symptoms, and laboratory tests, as well as postprocedural data were collected. The data were, subsequently, compared between the men and women. Results: Out of the 44,820 patients (16,378 women), who underwent coronary angiography, 37,358 patients (11,995 women) had CAD. Amongst the CAD patients, the females were not only significantly older, less educated, and more overweight than were the males but also had higher levels of triglyceride, cholesterol, low-density lipoprotein, highdensity lipoprotein, and fasting blood sugar (P< 0.001). Of all the risk factors, hypertension and diabetes mellitus showed the strongest association in our female CAD patients (OR=3.45, 95%CI: 3.28-3.61 and OR=2.37, 95%CI: 2.26- 2.48, respectively). Acute coronary syndrome was more prevalent in the men (76.1% vs. 68.6%, P< 0.001), and chronic stable angina was more frequent in the females (31.4% vs. 23.9%, P< 0.001). With respect to post-procedural recommendations, the frequency of recommendations for non-invasive modalities was higher in the females (20.1% vs. 18.6%, P< 0.001). Conclusion: Hypertension and diabetes mellitus had the strongest association with CAD in our female patients. In the extensive CAD patients, medical treatment was recommended to the women more often.

Background: Human error and deficient non-technical skills (NTSs) among providers of ALS in helicopter emergency medical services (HEMS) is a threat to patient and operational safety. Skills can be improved through simulation-based training and assessment. Objective: To document the current level of simulation-based training and assessment of seven generic NTSs in crew members in the Norwegian HEMS. Methods: A cross-sectional survey, either electronic or paper-based, of all 207 physicians, HEMS crew members (HCMs) and pilots working in the civilian Norwegian HEMS (11 bases), between 8 May and 25 July 2012. Results: The response rate was 82% (n=193). A large proportion of each of the professional groups lacked simulation-based training and assessment of their NTSs. Compared with pilots and HCMs, physicians undergo statistically significantly less frequent simulation-based training and assessment of their NTSs. Fifty out of 82 (61%) physicians were on call for more than 72 consecutive hours on a regular basis. Of these, 79% did not have any training in coping with fatigue. In contrast, 72 out of 73 (99%) pilots and HCMs were on call for more than 3 days in a row. Of these, 54% did not have any training in coping with fatigue. Conclusions: Our study indicates a lack of simulation-based training and assessment. Pilots and HCMs train and are assessed more frequently than physicians. All professional groups are on call for extended hours, but receive limited training in how to cope with fatigue.

5. Managers’ working hours and time allocation in effective SMEs – an organizational health perspective

Ahmadi, Elena

et al.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.

Macassa, Gloria

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.

Larsson, Johan

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.

There is an increased global interest in occupational health across small businesses as they represent a large share of employers in many societies. In the model of healthy work organisations, employee health is a prerequisite for higher productivity and profitability and management practices are considered as determinants of organisational health. A better understanding of how managers in effective companies use their time can offer a better understanding of how this can affect employees’ well-being and business effect-iveness. Managers’ long working hours and share of time spent on Management by Walking Around (MBWA) are considered important characteristics of managers’ work that might have consequences for employees’ and managers’ own health outcomes, as well as for organisational effectiveness. MBWA is a management technique common for successful companies in regard to their effectiveness; providing an opportunity for a spontaneous manager-subordinate interaction that might be important for employee health and wellbeing. Studies of managerial work have to some extent not clearly placed managers’ time use in the broad context of leadership, often missing to link it with leadership behaviour theories, health and effectiveness.

Objective

The objective of this study was to explore, on the one hand, the total amount of working hours that managers spent, and on the other, their patterns of time allocation to different activities in effective SMEs. Research questions were: 1) What patterns regarding managers’ working hours can be identified across socio-demographic variables, leader-ship experience factors and leadership profiles in effective SMEs? 2) What patterns regarding proportions of total working hours spent on MBWA can be identified across socio-demographic variables, leadership experience factors and leadership profiles in effective SMEs?

Method

The study used data collected within the project, “Successful Companies in Gästrikland”. Annually the project nominates 120 companies for the award based on companies’ financial indicators. The study employed a cross-sectional design and analysed responses to questionnaires collected within the project during years 2014-2018. The inclusion criteria were small and medium sized companies (more than four and less than 250 subordinates), high-level managers having subordinates. Data analysis were carried out using descriptive statistics and regression analysis.

Results

The results section is being processed and will be reported on the conference.

6. FRAMFÖR (Framgångsrika företag i Gästrikland)

Ahmadi, Elena

et al.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.

Vilhelmson, Pär

University of Gävle, Faculty of Education and Business Studies, Department of Business and Economic Studies, Business administration.

Macassa, Gloria

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.

Larsson, Johan

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.

Strömberg, Annika

University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.

Gustafsson, Susanne

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.

Lindberg, Per

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.

The concept of healthy workplace has been defined as an organization that maximizes the integration of worker goals for wellbeing and company objectives for profitability and productivity. Conditions in today’s working life make new approaches necessary in order to limit negative health effects of work and to enhance wellbeing and health at work. About 24 % of the working population in Sweden report to have had work-related disorders during the last twelve months. In order to achieve a sustainable working life it is likely that strategies and actions from different and new angles are needed.ObjectivesThe present study is a part of a larger study (the GodA –study; a Swedish acronym for good work environments and healthy workplaces) and aims to investigate how work environment factors, work ability, work motivation, work and life balance predict well-being at work.

Methods

The GodA study is a 2-year follow up study in Sweden with a survey feedback design in three companies with both blue- and white collar workers. One of the companies serves as “intervention-company”, the other two as controls. A baseline questionnaire was sent out 2013 and the results from the survey were reported back to the companies, which have been processing their results. In spring 2015 a follow up survey has been administered. Data have been analysed with univariate and multivariate linear regression analyses.

Results showed that not only work environment factors are important predictors. To maintain a healthy work place a promotion of balance between work and private life is needed.

8. Predictors of well-being at work

Anderzén, Ingrid

et al.

Department of Public Health and Caring Sciences, Uppsala University.

Lindberg, Per

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.

Karlsson, Thomas

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.

Strömberg, Annika

University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.

Gustafsson, Susanne

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.

The concept of healthy workplace has been defined as an organization that maximizes the integration of worker goals for wellbeing and company objectives for profitability and productivity. Conditions in today’s working life make new approaches necessary in order to limit negative health effects of work and to enhance wellbeing and health at work. About 24 % of the working population in Sweden report to have had work-related disorders during the last twelve months. In order to achieve a sustainable working life it is likely that strategies and actions from different and new angles are needed.

The present study is a part of a larger study (the GodA –study; a Swedish acronym for good work environments and healthy workplaces) and aims to investigate how work environment factors, work ability, work motivation, work and life balance predict well-being at work.

Methods

The GodA study is a 2-year follow up study in Sweden with a survey feedback design in three companies with both blue- and white collar workers. One of the companies serves as “intervention-company”, the other two as controls. A baseline questionnaire was sent out 2013 and the results from the survey were reported back to the companies, which have been processing their results. In spring 2015 a follow up survey has been administered. Data from the baseline measurements have been analysed with univariate and multivariate linear regression analyses.

Results

A baseline multivariate linear regression model, which included background factors, perceived psychosocial work climate and work environmental factors (motivation, leadership, employee responsibilities, efficacy, work ability and management committed to employee health) and work life balance, showed that psychosocial work climate (B= .48, 95% CI=.27 – .69) leadership, (B= .27, 95% CI=.05– .49), work ability (B= -.12, 95% CI= .03 – .21), motivation (B= -33, 95% CI= .14 – .51) and work life balance (B= -.34, 95% CI=-.57– -.12), were significantly associated with well-being at work and explained 40% of the variance (Adjusted R2=.40, p<.001). Results from the two-year follow up will be presented at the conference.

Conclusions

Results showed that not only work environment factors are important predictors. To maintain ahealthy work place apromotion ofbalancebetween workand private life is needed.

9. Prevalence of suicide ideation among adolescents and young adults in rural Bangladesh

Suicide is a leading cause of death world-wide. However, adolescent suicidal behavior is a neglected public health issue, especially in low-income countries such as Bangladesh. The study was conducted to estimate the prevalence of suicidal ideation among adolescents in a rural community and to examine factors associated with suicidal ideation. A cross-sectional survey was carried out in 2013 among 2,476 adolescents aged 14–19 years, selected randomly from a rural community of Bangladesh. An adapted version of the WHO/SUPRE-MISS questionnaire was used to collect data in the Raiganj sub-district. A two stage screening was performed to identify the suicidal ideation cases. It was found that the life-time prevalence for suicidal ideation was 5 percent among adolescents. The majority of the adolescents with suicidal ideation were females 66 (52.8%), unmarried 103 (82.4%), and students 92 (73%). Suicidal ideation was statistically significantly associated with age, education, occupation, living with parents or others, and house ownership. Respondents who were aged 18–19 years, had secondary school certificate (SSC) and secondary school certificate (HSC) or higher education, were day laborers, had own house, and do not lived with parents had odds ratios of 2.31 (CI 1.46–3.65), 2.38 (CI 1.51–3.77), 4.15 (CI 2.41–7.14), 0.28 (CI 0.13–0.60), 0.14(CI 0.05–0.35), and 1.80 (CI 1.07–3.03), respectively. Among adolescents, the prevalence of life-time suicidal ideation was moderately high. Age, education, occupation, house ownership, and living with parents were statistically significantly associated with suicidal ideation. It is important to design and implement effective community based suicide prevention programs for adolescents in Bangladesh.

Department of Epidemiology, Bangladesh University of Health Sciences, Dhaka, Bangladesh.

Macassa, Gloria

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Sciences, Mid-Sweden University, Sundsvall, Sweden.

Background: Suicide is a leading cause of death world-wide and becoming a public health concern among adolescents. However, adolescent suicidal behaviour is a neglected public health issue, especially in low-income countries such as Bangladesh. Of great importance is the understanding of which factors might be related to this growing public problem.

Objective: To examine the relationship between parental socio-economic position and suicide ideation among adolescents in rural Bangladesh

Methods: A cross-sectional survey was conducted in 2013 among 2,476 adolescents, aged 14-19 years, selected randomly from a rural community of Bangladesh. An adapted version of the WHO/SUPRE-MISS questionnaire was used to collect data in the Raiganj sub-district, which is a surveillance area of the Centre for Injury Prevention and Research, Bangladesh (CIPRB).

Descriptive statistics and binary logistic regression analyses were used to analyze the data. Comparisons of proportions between groups were carried out using the χ2 test. Multivariate logistic regression analysis was used to examine the relationship between parental co-variants and suicidal thoughts among adolescents. The significance level was set atp <0.05. All analyses were performed using SPSS 20.

Results: The majority of parents had education only up to primary school (mothers 58.7% and fathers 49.5%). Most of them were farmers (53.3% of fathers) and housewives (96.5% of mothers). Monthly income and expenditure of the adolescent’s parents were mainly upto 10,000 taka only. Suicidal ideation is more common among adolescents of low income group parents 104 (5.5%) and who were not living with their parents 18 (8.2%). Adolescent’s suicidal ideation was found to be significantly associated with education, marital status and house ownership of their parents. Not being able to live with their parents was also a significant factor. Parents who received education up to SSC had odds ratio of 2.10 (1.21,3.64) and 1.92 (1.15, 3.23) for mothers and fathers respectively. Parent’s income or expenditure was not associated with adolescent’s suicidal ideation. Adolescent’s suicidal ideation of single parents had higher odds (OR 3.00, CI 1.75-5.19) in comparison to adolescents who had both parents. Adolescents whose parents owned a house and who weren’t living withtheir parents had odds ratios of 0.14 (0.05,0.35), and 1.80 (1.07,3.03) respectively. After adjusting for other covariates parents’ marital status and house ownership significantly associated with the adolescent suicide ideation.

Conclusion: Parental socio-economic position was asso-ciated with suicidal ideation. Adolescent with single parents were more likely to report suicidal ideation. Low parental education and socio-economic status, marital status, house ownership, not living with parents at home as well as adolescent loneliness were the important factors for suicidal ideation.

11. Bara vara mig själv

Berneholt, Emelie

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.

The purpose of this paper was to explore the students experiences of the school climate and how it affects their well-being. Semi-structured interviews with an interview guide were used as a method. The sample was of six students in the age of 11-13 from one middle school class. The results showed among other things that almost everyone felt safe at school and expressed different definitions of safety such as feeling welcome and feeling like they can be themselves. The students felt supported by the teachers, other students and also their parents. Some things the school should change according to the students were the classrooms which were too small and with inefficient soundproofing, the school yard which was boring, and the fact that the students sometimes wanted more adult supervision during school breaks. The conclusion is that the school climate can affect student’s well-being and that a small school can have both pros and cons regarding the school climate. More qualitative research may result in a better understanding of the way the school climate affects the students.

Björklund, M. (2017). Is the use of Instagram a new self-harm behaviour? A cross-sectional study of Instagram users’ reflections. Bachelor thesis in Public Health Science. Department of Occupational and Public Health Science. Faculty of Health and Occupational Studies. University of Gävle, Sweden.

The aim of the study was to investigate the use of Instagram among Swedish internet users. A further aim was to investigate whether there was an association between the increased use of Instagram and mental health.

The method used was a cross-sectional study with questionnaires. Both quantitative and qualitative questions were included in the survey, which were presented as descriptive statistics as well as thematic analysis with quotes. The selection was a convenience selection and snowball selection, where the surveys were disseminated via the author Facebook.

The result showed that the majority used Instagram several times a day and many of them were found to be in the risk group of mental illness. Many users found that the images exposed in Instagram contributed to comparisons between themselves and the photos resulting in body dissatisfaction.

The conclusion was that the use of Instagram several times a day was associated with a decreased level of well-being. The majority of the Instagram users compared themselves with other people and more thought of their appearance, when they were exposed to the images in Instagram.

The purpose of this study was to investigate if the environment at home could affect the pupils breakfast intake; what they choose to eat, if the eat and why they eat breakfast. A quantitative method was used and the data was collected by a questionnaire. In total 64 pupils from ninth grade in public school participated in the study. The result showed that most of the pupils ate breakfast regularly and often ate alone at the kitchen table. Though some of them ate very little and a meager breakfast. Most of the pupils were positive to being served breakfast at school because they often were too tired to eat at home and can eat in the company of friends. The conclusion was that most pupils ate breakfast often and a few ate rarely. The kitchen table was the preferred place to eat breakfast and they often ate alone. Popular choices for breakfast were oatmeal, sandwiches or soured milk/yoghurt with cereals.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Portugal.

The aim was to estimate the prevalence of sexual and physical intimate partner violence (IPV) and its associated factors, in a sample of pregnant women using antenatal care (ANC) in Nampula province - Mozambique. This cross-sectional study was carried out in six health units in Nampula, from February 2013 to January 2014. Overall, 869 participants answered the Conflict Tactics Scale 2. The lifetime and past year prevalence of sexual abuse was 49% and 46%, and of physical abuse was 46% and 44%, respectively. Lifetime and past year sexual abuse was significantly associated with living as a couple, alcohol drinking and having a past diagnosis of gonorrhea. Lifetime and past year physical abuse increased significantly with age and was associated with living as a couple, alcohol drinking and history with syphilis. The prevalence of lifetime and previous year violence among women using ANC was high and similar showing that most women were constantly exposed to IPV. ANC provides a window of opportunity for identifying and acting on violence against women.

This report brings together 12 invited presentations and outcomes of a workshop on food and meals for employees working irregular hours “around the clock”. The workshop, “Food at work around the clock – The Nordic Model”, was hosted by the National Food Institute at the Technical University of Denmark on November 4, 2016, in Lyngby, near Copenhagen, Denmark. This was a culmination of the collaboration started in 2015 between researchers from the hosts institute, Gävle University and Kristianstad University in Sweden, and the School of Applied Educational Sciences and Teacher Education in Finland. The workshop was funded by the Nordic Council of Ministers.

Introduction The Swedish Work Environment Authority has developed a new guideline that gives employees a great responsibility to promote a good working environment and prevent ill health among their employees. The reason that these guidelines have been developed is that illness among employees at work in Sweden has increased.

Background At a workplace in a medium sized city in Sweden a group of employees was offered to participate in a health promotion intervention. The goal of the intervention was to give the employees the best conditions for prosperous health and a chance to improve their lifestyle, if they had a need for it. With the help from a coach, the employees worked in groups and individually in areas such as stress, nutrition, physical activity, ergonomics and mental health, and it was the individual´s needs and interests that guided the entire process.

The aim of the study was to examine what the participants experienced when participating in a workplace intervention with focus on health promotion.

The method used in the study was a semi-structured interview with four participants, both men and women aged twenty five to sixty three, which were subsequently analyzed through a qualitative content analysis.

The result showed that the workplace as an arena was of great importance for the individuals. It was perceived as positive that the intervention took place during work hours, otherwise it would have been doubtful that the participants would have participated. It was important for the individuals to discuss the process they went through with their colleagues. However, all participants experienced a sense of shame and did not want to share their inner thoughts with their colleagues. It turned out to be difficult to formulate their individual goals, their focus was instead on what others expected from them.

The conclusion was that fear of failure among the participants was the reason why they did not want to share their individual goals with their colleagues. In order to continue to feel motivated for a change in life style, the support from the coach and colleagues was necessary.

The purpose of this study has been to examine what attitudes young adults have on drugs by problematizing what influence education might have on potential drug use. Furthermore, the study wants to scrutinize how primary schools use Alcohol, Narcotics. Doping, Tobacco teaching (ANDT).

The method used for acquiring empirical data constituted of two focus groups with a total of ten young adults and a survey with twelve primary school principals. The conversations from the focus groups were recorded, transcribed and analyzed thematically which resulted in four different themes.

The results demonstrate that the respondents have shaped their attitudes on drugs through their parents during their upbringing. Furthermore, the results display how attitudes on drugs might be influenced by peer pressure. However, teaching in school did not show any correlation to the respondents’ attitudes.

The conclusion of the studyis that knowledge about drugs in general might result in a better understanding about the consequences, for instance how drug use damages the body and might create an addiction. The study shows that the attitudes among young adults are shaped under influence of several factors and arenas, but that further research on the topic is still needed for the public health.

2440 cases of sexual child abuse was reported in 2015 in Sweden that is about one out of five children. Research shows that prevention strategies that focus on strengthening children’s integrity have proven effective for helping children recognize abusive behaviors as well as gain confidence to disclose.

The aim of this study is to investigate and describe the preschools role in strengthening children’s integrity to prevent child abuse, and describe how the work is done. The study has a qualitative approach with mix of semi-structured and unstructured interviews, called a qualitative interview form. This study used a purposive selection, four informants with management position within preschool were interviewed. The interviews were recorded and then transcribed, which will serve as a database for analysis. For this study a content analysis was chosen.

The results showed that the preschool work aims to strengthen children’s integrity, but that the pre-schools do not use any specific strategies to strengthen children’s integrity with the aim of preventing child abuse.

The conclusion showed that the preschool does not work consciously to prevent sexual child abuse, instead they are focusing in strengthening children’s integrity and values.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.

Melchiorre, Maria Gabriella

Centre for Socio- Economic Research on Ageing, Italian National Institute of Health and Science on Aging, INRCA, Ancona, Italy.

Barros, Henrique

Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal.

This study aimed to investigate the association of lifetime abuse and mental health among older persons, considering associated factors (e.g., demographics) through a cross-sectional design. We recruited 4,467 women and men ages 60–84 years from 7 European cities. Mental health was measured with the Hospital Anxiety and Depression Scale, and abuse (psychological, physical, sexual, financial, and physical injuries) based on the Revised Conflict Tactics Scale and the UK survey of abuse/neglect of older people. Multiple logistic regression analyses showed that country of residence, low educational level, and experienced financial strain increased the odds of probable cases of anxiety and depression. Female sex, white-collar profession, and financial support by social/other benefits/or partner income were associated with higher odds of anxiety, while older age and experience of lifetime injury were associated with increased odds of depressive symptoms. The findings of this study indicate that socioeconomic factors, as well as experienced lifetime severe physical abuse leading to injuries, are significant in perceived mental health of adults in later life.

Objective The objective of this study is to compare coping strategies between adults with and without congenital heart disease and to scrutinize the associations between different available resources (e.g., social support) and adoption of certain coping strategies.

DesignThe study has a cross-sectional case-control design.

SettingThe study was conducted in two university-affilliated heart hospitals in Tehran, Iran.

Outcome Measures Coping strategies, assessed with the Utrecht Coping List-short form, were compared between both groups. Block-wise multiple regression analyses were conducted to scrutinize the associations between different independent variables (e.g., demographic/socioeconomic statuses) and adoption of certain styles of coping (dependent variables) among all participants and separately for each group.

Results The styles of coping in the patients were comparable with those of the control group. Multivariate analyses revealed that congenital heart disease per se was not associated with style of coping except for palliative reaction pattern. The active problem-solving coping style was associated with never married marital status, parenthood, unemployment, higher level of anxiety/somatic symptoms, lower level of depressive symptoms, and better social support. The avoidance behavior style was associated with having a low income, whereas the expression of emotion style was associated with higher anxiety symptoms, experience of financial strain, and income. None of the adopted coping strategies was related to the heart disease variables.

Conclusions The adults with congenital heart disease coped as well as adults without congenital heart disease. Marital status, parenthood, annual income, financial strain, psychological adjustment, and perceived social support were important explanatory factors in adopting a certain style of coping among adults with congenital heart disease. However, longitudinal studies with repeated measures are warranted.

Background Life-expectancy of adults with congenital heart disease (CHD) has improved world-wide, but there are limited data on these patients' experiences of quality of life (QoL), life satisfaction (LS), and their determinants (e.g. social support), particularly among patients from developing countries.

Design Cross-sectional case-control.

Methods A total of 347 CHD patients (18-64 years, 52.2% women) and 353 non-CHD participants, matched by sex/age, were recruited from two heart hospitals in Tehran, Iran. LS and QoL served as dependent variables, and demographic/socioeconomic status, mental-somatic symptoms, social support, and clinical factors (e.g. defect category) served as independent variables in multiple regression analyses once among all participants, and once only among CHD patients.

Results The CHD patients had significantly lower scores in LS and all domains of QoL than the control group. However, having CHD was independently negatively associated only with overall QoL, physical health, and life and health satisfaction. Additionally, multivariate analyses among the CHD patients revealed that female sex, younger age, being employed, less emotional distress, and higher social support were significantly associated with higher perceived QoL in most domains, while LS was associated with female sex, being employed, less emotional distress, and better social support. Neither QoL nor LS was associated with cardiac defect severity.

Conclusions The adults with CHD had poorer QoL and LS than their non-CHD peers in our developing country. Socio-demographics, emotional health, and social support were important 'determinants' of QoL and LS among the CHD patients. Longitudinal studies are warranted to establish causal links.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden.

Khankeh, Hamid Reza

Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Despite the improvement in life-expectancy of adults with congenital heart disease, they may experience unique medical and social challenges that could impact on their psychological functioning. The aims of this study were to address the experience of anxiety, depressive and somatic symptoms among adults with congenital heart disease in comparison with that of non-heart diseased persons considering the role of various factors (e.g. socio-economic).

Methods

In cross-sectional case–control study, the participants consisted of 347 patients with congenital heart disease (18–64 years, 52.2% female) and 353 matched (by sex/age) non-heart diseased persons. The participants completed a questionnaire. The data were analyzed with bivariate and multivariate methods.

Results

In bivariate analyses, scores in anxiety and somatic symptoms were higher among patients than the healthy controls (both at p ≤ 0.001), whereas the groups did not differ in depressive symptoms. Following multiple-linear-regression-analyses, only the association between congenital heart disease and somatic symptoms was confirmed. Among the patients, perceived financial strain was significantly related to anxiety, depressive and somatic symptoms; lower perceived social support to anxiety and depression; and low annual income to somatic symptoms. Additionally, somatic symptoms were associated with anxiety and depressive symptoms, and vice versa. And no medical variables were related to anxiety, depressive and somatic symptoms.

Conclusions

Congenital heart disease was only independently associated with somatic symptoms. Financial strain, social support and co-existence of emotional distress with somatic symptoms should be considered in developing appropriate interventions to improve the well-being of patients with congenital heart disease. However, longitudinal research is warranted to clarify causality.

24. The prevalence of lifetime abuse among older adults in seven European countries

Eslami, Bahareh

et al.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.

Melchiorre, Maria Gabriella

Centre for Socio-Economic Research on Ageing, Italian National Institute of Health and Science on Aging, I.N.R.C.A, Ancona, Italy.

OBJECTIVES: To investigate the lifetime prevalence rate of abuse among older persons and to scrutinize the associated factors (e.g. demographics).

METHODS: This cross-sectional population-based study had 4467 participants, aged 60-84, from seven European cities. Abuse (psychological, physical, sexual, financial and injuries) was measured based on The Revised Conflict Tactics Scale, and the UK survey of abuse/neglect of older people.

CONCLUSIONS: High lifetime prevalence rates confirm that elder abuse is a considerable public health problem warranting further longitudinal studies. Country of residence is an independent factor associated with all types of elder abuse which highlights the importance of national interventions alongside international collaborations.

Background Providing appropriate care for adults with congenital heart disease requires the evaluation of their current situation. There is limited research in Iran about these patients, particularly in relation to gender differences in the demographic/socio-economic and lifestyle factors, as well as disease parameters.

Materials and methods The sample consisted of 347 congenital heart disease patients in the age group of 18–64 years, including 181 women, assessed by an analytical cross-sectional study. The patients were recruited from the two major heart hospitals in Tehran. Data were collected using questionnaires.

Results The mean age of the patients was 33.24 years. Women were more often married and more often had offspring than men (p < 0.001). Educational level and annual income were similar between women and men. Unemployment was higher among women (p < 0.001), but financial strain was higher among men (p < 0.001). Smoking, alcohol, and water-pipe use was higher among men than among women (p < 0.001). Cardiac factors, for example number of cardiac defects, were similar among women and men, except that there were more hospitalisations owing to cardiac problems, for example arrhythmia, among men. Disease was diagnosed mostly at the hospital (57.4%). Most medical care was provided by cardiologists (65.1%). Only 50.1% of patients had knowledge about their type of cardiac defect.

Conclusion Gender differences exist in the socio-economic and lifestyle characteristics of adults with congenital heart disease, in some cases related to the disease severity. Our findings also point to the need for interventions to increase patients’ knowledge about, and use of, healthier lifestyle behaviours, irrespective of gender. Furthermore, providing appropriate jobs, vocational training, and career counselling may help patients to be more productive.

The purpose of this study was to investigate how nurses describe their meals at work, and how meals at work was described as a possibility to recover.

The method had a qualitative approach with semi-structured interviews. Five nurses participate and were recruited through a snowball sampling. The interviews were recorded and then transcribed. To analyze the data a manifest content analysis was used.

The result showed that the four categories content and meaning for meals at work, environment for the meal at work, time to eat and social relations at the dining table summarized the nurses' descriptions of meals at work. The meal at work was described as one way to recover, but many other things also helped recovering.

The conclusion was that nurses in this study described that meals at work can improve through enough length of the break, lower noise level, less stress while eating, enough room for eating and preparing food as well as nutritional food shall be available. The result of the study shows that meals are described as a chance to recover but also that the nurses associate recovery with night sleep, socialize with the family, perform physical activity or just gather your thoughts.

Department of Sociology, National School of Public Health, Athens, Greece.

Lindert, Jutta

Department of Public Health, University of Emden, Emden, Germany; Women's Studies Research Center, Brandeis University, Waltham, MA, United States.

Macassa, Gloria

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.

Stankunas, Mindaugas

Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania; Department of Health Service Management, Centre for Health Innovation, School of Medicine, University of Griffith, Gold Coast, QLD, Australia.

Torres-Gonzales, Francisco

Network of Biomedical Research on Mental Health Centers, University of Granada, Granada, Spain.

Few studies have evaluated the impact of lifetime abuse on quality of life (QoL) among older adults. By using a multinational study authors aimed to assess the subjective perception of QoL among people who have reported abuse during the course of their lifetime. The respondents (N = 4,467; 2,559 women) were between the ages of 60 and 84 years and living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain, and Sweden). Lifetime abuse was assessed by using a structured questionnaire that allowed to assess lifetime experiences of abuse. QoL was assessed with the World Health Organization Quality of Life-Old module. After adjustment for potential confounders, authors found that to have had any abusive experience decreased the score of sensory abilities. Psychological abuse was associated with lower autonomy and past, present, and future activities. Physical abuse with injuries significantly decreased social participation. Intimacy was also negatively associated with psychological abuse, physical abuse with injury, and sexual abuse. The results of this study provide evidence that older people exposed to abuse during their lifetime have a significant reduction in QoL, with several QoL domains being negatively affected.

The aim of this study was to examine the prevalence of cyberbullying, reactions and mental health associated with this new phenomenon. The method used was a cross sectional study with a web-based survey which was conducted on 18-19 year olds in high school. A total of 75 young adults completed the survey. The result showed that it was more likely to suffer from cyberbullying than traditional bullying. The victims of cyberbullying reported poorer health than non-affected and suffered from self-injuries, the most common reaction associated with cyberbullying was to feel sad and suffer from anxiety. Cyberbullying was more common at the college preparatory high school program. The conclusion that can be drawn is that cyberbullying is a widespread phenomenon among young adults and cyberbullying victims feel worse than non-affected and victims also suffered from suicidal thoughts. The school should create clear guidelines on how to handle cyberbullying, and these should continuously be monitored and communicated to staff and students. More research in this area is needed to investigate the causes and behavior of both victims and perpetrators to create methods to prevent and manage cases of cyberbullying.

29. Adherence and social antecedents in relation to outcome in Methadone Maintenance Treatment (MMT)

Gronbladh, Leif

et al.

Department of Neuroscience, University of Uppsala, Sweden; University hospital, Uppsala, Sweden.

Öhlund, Lennart S.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Sciences, Aalesund University College, Norway.

Numerous reports of the effectiveness of methadone in reducing opiate use as well as mortality, criminality, prostitution and the risk for HIV-infection have been published during the last forty years. However, poor adherence to treatment, continuing drug use and increasing rate of premature termination may lead to less than optimal outcome results or in too many cases death. The aim of this paper is to investigate which of the background variables, collected at the admission procedure, that can be used to tell which type of patient will adhere to the treatment regime and succeed or who will fail and who either need special considerations or ought not to be accepted for a methadone treatment (MMT). As much as 86 percent of the compliers in this study did benefit from the treatment and were rated as medium to very much improved according to CGI-I. The group not improved or worse had significantly more background problems such as school problems, a history of non-opioid abuse, many non-MMT treatment episodes, low age at drug debut and opioid debut than the group much or very much improved. Those moderately improved is usually situated somewhere in between the others.

30. Self-reported differences in side-effects for 110 heroin addicts during opioid addiction and during methadone treatment

Grönbladh, Leif

et al.

University of Uppsala.

Öhlund, Lennart

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Sciences, Aalesund University College, Norway .

Although methadone maintenance treatment (MMT) has been shown to be effective, poor compliance is always a threat. It has often been pointed out that one variable that inevitably reduces adherence to treatment regimes is the negative side-effects of the treatment. This study examines seventeen known side-effects in a sample of 110 former opiate addicts consecutively admitted to methadone maintenance treatment. Self-reported side-effects were collected through a questionnaire. Despite the considerable increase, from 23 to 74% of the sample, in the proportion that reported individual side-effects between the period of opiate use and that of methadone treatment, the overall result was a significant decrease in eleven symptoms, no change in four and a substantial increase in only two. In some individuals a symptom that is liable to be problematic actually does become problematic, while the same symptom becomes less frequent in the group as a whole. Weight gain is the symptom that increases most in the whole group and needs to be constantly monitored. Other side-effects that remain high and need to be kept under review in clinical practice are nervousness, decreased libido, daytime drowsiness, constipation and perspiration.

31. Managerial masculinity : an issue for wellbeing at work.

Gustafsson, Susanne

et al.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.

Anderzén, Ingrid

Department of Public Health and Caring Sciences, Uppsala University.

Lindberg, Per

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.

In this paper we reflect on potential linkages within and between masculinity, management and wellbeing. The aim is to reveal the tensions in which technocratic managerial masculinity faces difficulties when combined with fathering and its consequences for wellbeing, both on individual- and family level.

Methods

Audio-recorded life-history interviews were conducted with employees, at three companies in Sweden during spring 2014. One of them was with a former manager, also a father, which is the subject of this paper. The tran-scribed interview formed the basis of an individual case study that was interpretive analyzed using a gender theoretic approach.

Results

Managerial masculinity is revealed as obstacles such as hegemonic expectations of not being good enough which is emerging in contradictive situations between hospital visits and office deadlines. To cope with hege-monic masculinity displaced in a contradictive cornerstone the embodiment of thoughts, ideas and experien-ces became transformed into a wish to quit the leadership assignment, a process in which support from colle-agues, relatives and friends were recognized as important. The decision to quit was immediately followed by a relief, but over time became mixed-up with sorrowful feelings of lack. Looking back at the event makes a shift in value-system prominent: The informant’s self-understanding has been transformed from prioritizing level of sa-lary and the value of money to instead emphasize broader values in life expressed in terms of family wellbeing.

Conclusion

Through the tensions that emerge from ‘changing faces of masculinity’ the capacity to navigate life is reshaped. As long as hegemonic masculinity is taken for granted it is difficult to challenge and question it. But when ideas, experiences and feelings are transformed from a personal- to a cultural level they become possible to share with others: a process of exchange through which alternative ways of doing are crystallized. Personal experi-ences are thus transformed into collective possessions and given new meanings. We interpret the exchange of thoughts and ideas as expression of supportive interaction, shown to prompt new kinds of enactment in personal lives – thus a potential for wellbeing at work

32. Rethinking potential connection between gender, work- and family life and how to link the emerging reasoning to well-being

Gustafsson, Susanne

et al.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.

Lindberg, Per

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.

How women and men negotiate roles and relationships is crucial for having the potential to combine paid work with other parts of their life. How women and men actually do this can be understood as constrained by what women and men are expected to do. Earlier research on organizational working patterns has revealed links between such constraints and gender relations (Acker, 1990). ”Processes of transformation” (Gustafsson, 2007) is a theoretical concept that will be used here in this paper to explore a potential connection between working life and family life, as varying and gendered. How these two spheres of life are situationally connected will have implications for well-being. It is this theoretical reasoning that will be illustrated in this paper, how it works in practice, through the use of empirical examples from an ongoing larger study on work and health.

In mainstream literature, the term “work–life balance” is frequently used, often in very simplified ways, concealing underlying dynamism and complexity. “Women” as a group and “men” as a group are often seen as fixed, unproblematic gender categories, classifying bodies and therewith define gender. It is therefore not surprising that gender categoricalism can become the basis in occupational health. If categorical thinking on gender is parked on the top of biological difference, gender relations and “roles” correspond with natural differences and thus serve to mask how underlying gender relations, contradictive and ambivalent, produce and reproduce men’s privileged position simultaneously with women’s subordination (Connell, 1987). Using categorical thinking on gender risk to become contradictive, since expected change in health promotion programs at work may fail.

To understand how a balance can be struck between work and family-life obligations, contradictions and ambivalences need to be made visible and gender variations as well as nuances have to be sought for. We herewith call for a re-thinking of how the connection between gender, work, family and well-being can be seen and practiced through occupational health policy. An analytical tool able to facilitate this re-thinking in occupational health practices will be suggested in this paper. We are convinced that it is this kind of concepts that are needed right now in order to mobilize an acceleration of ongoing gender transformation that would contribute to improve health and well-being, both in work and family spheres of life.

This paper is part of a comprehensive intervention study on occupational health and well-being among blue- and white-collar workers, both women and men, in three companies in Sweden. In the baseline questionnaire, the employees mentioned that work–life balance is most significant for them as they strive to achieve well-being and health. This is the motivation for a study whose overall purpose is to contribute to a better understanding of potential linkages between gender, work and family, and well-being. The aim of this paper is threefold. First, it focuses on how employed women and men “do gender” when combining earning and caring activities and looks at the contributions or limitations or both. Second, it considers how the gender regime can be seen as providing a context for various gender-related limitations and opportunities, and differences and similarities between the employed women and men in three companies in Sweden. Third, it illuminates an alternative approach for combining gender, work, family and well-being.

33. Using gender as analytical tool in an analysis of a manager's health

Gustafsson, Susanne

et al.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.

Lindberg, Per

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.

Introduction: It is a lack of research on the meanings of genderdynamism in relation to manager’s health in Sweden.The purpose of this paper was therefore to reflect on whether gender form, -content and/or, -arena, either contribute to reproduce or transform surrounding condition on the job and in the family and also its consequences for health, both on individual and family level.

Methods: A semi-structured life-history interview was conducted with aformer manager on the basis of gender theory and written verbatim into a transcript. A life-history case was elaborated using gender as an analytical tool. By sorting and comparing already gendered life events, both on the job and in the family, the main findings evolved.

Results: Paradoxically a turning point in Jan’s life became prominent with a personal crisis, and this was explained by how several minor shifts of genderedform,-content and -arena co-occurred.This resulted in that a gender neutral form of agency appeared possible to try out in practice. When this was done the conditions on the job and in the family were shaped in accordance with what is meant with good lives for all.

Conclusion: In most gender research the force of gender is limited due to its cross-sectional focus through time. But with the life-history research gender relations become prominent in its multiplicity, illuminating minor shifts of ongoing processes of transformation, understood as patterns of agency.

The aim with this study was to compare and evaluate potential differences in self-assessed health between students where the school had worked systematically with MI and students where the school had not. To evaluate this a quantitative method through poll forms was used. 40 poll forms was sent to a school that did not use MI and compared the answers with existing poll forms from a school that used MI systematically. Theresults showed that boys from the school using MI had 10 times bigger chance of answering that they felt good than the boys that not have MI. The results for the girls did not indicate the same importance of the intervention. Instead the results showed that other factors, such as feeling sad, sleep quality and alcohol usage influenced their self-rated health. The conclusion from this is that the MI does have an effect on the self-assessed health for particularly boys.

Hansson, A. (2017). The experience of demands, control and social support among a group of health care providers in Central Sweden - a cross sectional study. Bachelor thesis in Public Health Science. Department of Occupational and Public Health Science. Faculty of Health and Occupational Studies. University of Gävle, Sweden.

Background: In Sweden, employees who work within health and social care is the largest occupational group and is also the group which accounts for the highest number of illness cases. Work in health care often means a variety of psychosocial workloads such as high demands, low control and lack of social support.

Aim: The aim of the study was to examine the experiences and/or presence of demands, control and social support among nurses and home care workers in their daily work in health care in a municipality in central Sweden.

Method: The study included 44 participants, 12 nurses and 32 home care workers. In a quantitative cross-sectional study, data was collected by use of a questionnaire designed by the author for the aim of the study. Participants reported their age, gender, working years and working hours, and answered questions about the experience and/or presence of demands, control and social support in their daily work.

Results: The majority of the respondents experienced social support at their workplace. However, respondents 44 years or younger, did rarely/did not experience high work demands from managers or colleagues.

Employees who worked more irregular hours experienced more often that they achieved expectations of what should be done from the care takers and their relatives. Respondents who had worked as caregivers 10 years or more, felt that their working hours were governed by the needs of care taker.

Conclusion: The results show that an inadequate psychosocial work environment, with high demands, low control and lack of social support, was not experienced and/or a present problem among the majority of the respondents. Further research and knowledge is needed on how the perception of demands, control and social support at work has an impact on the self-perceived health of municipal employees within the health care sector since the work leave due to illness in this sector in Sweden continues to rise.

Keywords: Demand, control and support, Public Health, Psychosocial Working Environment.

The fundamental cause of weight-related problems, from obesity to anorexia, is an imbalance between calories consumed and calories expended. The "nutritional status" concept embraces more than food-intake. It elucidates the dynamics between supply, demand and factors that affect metabolism, energy balance and energy expenditure. In recent years, major changes in the spatial-temporal structures of everyday life that could be possible contributors to weight-related issues of adolescents have emerged. A modern life style of low activity, irregular meal times, late-night food intake, stress and sleep deprivation possibly leads to a disturbed regulation of food intake which further can generate physical and/or psychological illnesses. Traditional studies of eating behavior use food diaries focusing on the average intake of energy and nutrients (e.g. Bellisle et al., 2003). Such methods are demanding for the respondent and require details about consumed amounts. A "Meal Matrix" (Lennernas & Andersson, 1999) has been used in studies of several different Swedish cohorts (e.g. Wissing et al., 2000). The Meal Matrix consists of seven food categories and eight different meal "types". Categorization is based on visible properties (food types) but at the same time reflecting invisible properties (nutrients). In the present study the Meal Matrix was developed further to be used as part of a questionnaire in a study of eating behaviors in 1281 adolescents between 12 and 17 years old in a southern Swedish municipality. Meal patterns in adolescents were assessed in relation to time of day for intake, sleep and physical activity. The aim of the study was to 1) test a self-report concept for food based classification of eating behaviors in adolescents, 2) to evaluate the nutritional quality of food and meals among them and 3) to get information about the rhythm of eating and slee-ping in relation to time of day and the biological clock.

Background: The easy access to social media and a focus on male and female body ideals that are presented in social media can lead to depression, anxiety and physical inactivity. From a public health perspective, the importance of a deeper knowledge of this phenomenon is essential for young women and men, and past studies of this subject among young men are few Aim: The purpose of this study was to study young men’s experiences and perceptions of their own health and body ideals in relation to health and body ideals presented on social media. Method: The study was conducted with an inductive approach with semi-structed interviews as data collection method. The sample consisted of six people between the ages of 18-25 who exercised at least twice a week. The material was analyzed using a thematic analysis. Results: The analysis of the results led to a main theme: Social media, health and body ideals – an interaction. The main theme consists of four sub-themes: Health as a resource, ill health as an obstacle, body ideals and ways to reach them, and media as an impact factor. In these sub-themes, codes were found, each of which relate to the main theme. Conclusion: Health is a comprehensive concept that includes many factors that contribute to a healthy lifestyle. The mass media’s production of health images is perceived by interviewed in this study as a fixation of the body ideals versus subjective health. For these participants, the experience of misleading health information is readily available while the correct health information is perceived as more difficult to get ahold of.

Background and objectives: From a public health perspective, it is important not only to improve and maintain health, but also to promote equality in health. Epidemiological research has showed the importance of work and unemployment in the development of socio-economic health inequalities, and peoples life chances are suggested to be conditioned by participation or exclusion from the labour market. The most recent economic recession has brought further changes to the labour market that might have aggravated the already multifaceted image of inequalities in health. Gävleborg County was one of the hardest hit counties in Sweden, which experienced a myriad of changes in the labour market that went beyond those of the Swedish national average, in terms of increase in flexible forms of employment, factory closures, and lay-offs. The overall objective of this thesis was to investigate the relationship between employment status and health-related inequalities in Gävleborg County, Sweden. In addition, the Specific objectives for the thesis were to: assess the relationship between employment status and self-reported health in Gävleborg (Study I); to estimate the relationship between employment status and suicidal ideation during the economic recession in Gävleborg (Study II); to estimate the prevalence of anxiety and depression among economically active people living in the Municipality of Gävle (Study III) and to assess experiences and perceptions of well-being after involuntary job loss in Gävle (Study IV).

Methods: Study I and II in this thesis used data from the 2010 Health in Equal Terms survey, a cross-sectional survey carried out in Gävleborg County in Sweden. A total of 4,245 individuals, aged 16–65 years were included in the analyses. Study III was performed in Wave 1 (baseline survey) of the Gävle Household, Labour Market Dynamics and Health Outcomes survey (GHOLDH), a panel survey with household as the follow-up unit. A total of 241 persons completed a self-administered postal questionnaire which collected information on the employment status and psychological health (anxiety and depression) among persons aged 18–65 years. The thesis used descriptive analyses and logistic regression models to describe and explore the relationship between employment status, self-reported health and suicidal ideation in Gävleborg County (Studies I and II). Descriptive analysis of means and a multiple regression analysis for adjusted means of HADS, were used in order to estimate the prevalence of anxiety and depression among economically active persons residing in the Gävle Municipality (Study III). Study IV used a qualitative approach to gain a deeper understanding of how involuntarily unemployed persons in Gävlexperceive their well-being. Sixteen unemployed men and women aged 28–62 were interviewed face-to-face. A purposeful sampling strategy was used in order to suit the research question and to increase the variation among informants. The interview texts in Study IV were analysed using thematic analysis.

Results: In Study I, the prevalence of poor self-reported health (SRH) was twice as high in the group of people who were not employed (42%) compared to the employed group (21.6%). Individuals outside the labour market had odds of poor health of 2.64 (Cl 2.28–3.05) compared to their employed counterparts. Controlling for other covariates reduced the risk slightly to 2.10 (1.69–2.60), but remained statistically significant. Moreover, other variables such as long-standing illness, age, income and lack of social support were associated with self-reported poor health. In Study II, among those not employed, 11.2% had been in a situation where they had seriously considered taking their life (at some time during the past 12 months). The corresponding figure for those employed was 2.9%. Unadjusted results of the logistic regression analysis revealed that people who were not employed had about a four times higher risk of suicidal ideation, with an OR of 4.21 (CI: 3.14–5.64) compared to their employed counterparts. Controlling for other covariates, reduced the risk from 4.21(CI 3.14–5.64) in model I, to 1.73 (CI 1.16–2.57) in model IV, but remained statistically significant. In addition, other variables were associated with suicidal ideation. In Study III, the prevalence and risk of anxiety and depression were high among people who were out of work. In the multiple regression analysis, compared to employed people, those who were not employed had a risk of anxiety of 7.76 (5.97–9.75) and 4.67 (3.60–5.74) for depression. Study IV revealed six different themes from the interviews: Work was perceived as the basis for belonging; loss of work affected people’s social life and consumption patterns due to changes in their financial situation. Feelings of isolation, loss of self-esteem, and feelings of hopelessness were reported, affecting the respondents’ physical well-being. Longer duration of unemployment increased the respondents’ negative emotions. Activities, structure, and affiliation in other contexts were reported as part of their strategy for coping with poor mental health.

Conclusion: This thesis found a statistically significant relationship between being outside the labour market and poor SRH, a high risk of suicidal ideation, anxiety, and depression during the recent economic recession. The relationship between employment status and SRH was partially explained by socioeconomic, demographic and lifestyle variables. In addition, the relationship between employment status and suicidal ideation was, for the most part, explained by demographic, socio-economic and self-reported psychological variables. Atxithe municipal level, the prevalence of anxiety and depression was higher among those who were out of the labour market as compared to those who were employed and the odds of anxiety and depression were higher among people out of the labour market, but this was less prominent for depression than for anxiety. Job loss created feelings of loss of dignity and belonging as a human being. The participants experienced feelings of worry, insecurity, and stress due to their changed financial situation, which in turn led to isolation and loss of self-esteem. Social support and having activities other than work gave structure and meaning to everyday life. The results of this thesis indicate a need for early detection and potential treatment of people out of the labour force and for being aware of the increased risk of poor health symptoms and disorders among unemployed individuals. The findings also indicate a need for primary prevention strategies, implying that policy-makers must pay attention to the health status of those who are out of work, especially during times of combined economic hardship and labour market fluctuations. However, longitudinal studies are warranted to shed further light on the mechanisms through which employment status and conditions impact physical and psychological health outcomes.

39. Employment Status and Inequalities in Self-Reported Health

Hiswåls, Anne-Sofie

et al.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Mittuniversitetet, Avdelningen för hälsovetenskap.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm Sweden.

Wijk, Katarina

Samhällsmedicin, Landstinget Gävleborg, Community Medicine, County Council of Gävleborg.

Öberg, Peter

University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.

Background: The aim of this study was to investigate the impact of employment status on self-reported health in gävleborg county.

Methods: The study used data from the 2010 health in equal terms survey, a cross-sectional survey carried out in gävleborg county in sweden. a total of 4,245 individuals, aged 16–65 years were included in the analyses. descriptive and logistic regression analyses were used to assess the relationship between employment status and self-reported health

Results: Individuals outside the labour market had odds of poor health of 2.64 (cl 2.28–3.05) compared to their employed counterparts. controlling for other covariates reduced the risk slightly to 2.10 (1.69-2.60), but remained statistically significant. In addition, other variables were associated with self-reported poor health.

Conclusions: This study found a statistically significant association between being outside the labour market and poor self-reported health. The relation was explained partially by socio-economic and demographic variables. More studies, in particular longitudinal, are needed to further investigate the observed relationships. Policy-makers within the gävleborg county need to pay attention to the health status of those out of work, especially during times of combined economic and labour market fluctuations.

Results of the study suggest the need to pay attention to the health status of those outside the labour market, especially during times of economic hardship.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Mittuniversitetet, Institutionen för hälsovetenskap; Karolinska Institutet.

Objective: Suicide is a public health problem and an important indicator of severe mental ill-health. Thus, identifying risk factors for suicidal ideation is a public health priority. The aim of this study was to examine the relationship between employment status and suicidal ideation in Gävleborg County. Method: The study used data from the 2010 Health in Equal Terms survey, a cross-sectional survey carried out in Gävleborg County in Sweden. A total of 4,245 individuals, aged 16–65 years were included in the analyses. Descriptive and logistic regression analyses were carried out to assess the relationship between employment status and suicidal ideation Results: Individuals outside the labour market had odds of suicidal ideation of 4.21 (CI 3.14-5.64) compared to their employed counterparts. Controlling for other covariates, reduced the risk from 4.21(CI 3.14-5.64) in model I, to 1.73 (CI 1.16- 2.57) in model IV, but remained statistically significant. In addition, other variables were associated with suicidal ideation. Conclusion: There was a statistically significant association between being out of work and suicidal ideation. The association was explained partly by demographic, socio-economic and self-reported psychological variables. Results of the study suggest the need for primary prevention strategies among those out of the labour market, especially during times of economic hardship.

41. Inequalities and Suicide Ideation during Recession Times

Hiswåls, Anne-Sofie

et al.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Mittuniversitetet, Avdelningen för hälsovetenskap.

Suicide behaviour is a serious public health problem as it imposes economic and human costs to individuals, families and communities. Available evidence from some European countries indicates a significant rise in suicides related to economic recession. However, the debate continues regarding the role of unemployment in the reported suicide rates. In Sweden, very few studies have investigated the relationship between suicide behaviours and employment status in the context of the recent economic crisis although unemployment increased nationally and across different counties.

The aim of this study was to examine the relationship between employment status and suicide ideation in Gävleborg, Sweden.

Methods

The study used data from a cross-sectional survey, Health in Equal terms, carried out in Gävleborg County in Sweden, 2010. A total of 4245 individuals, aged 16–65 years were included in the analysis. The relationship between employment status and suicide ideation was assessed using descriptive and logistic regression analyses.

Results

People who were not working had odds of suicide ideation of 4.21 (95% Cl 3.14–5.64) as compared to those employed. Controlling for other covariates reduced the risk to 1.73 (95% CI 1.16-2.57) but remained statistically significant. In addition variables like anxiety, self-reported stress and young age were also associated with suicide ideation. However among the covariates, people who reported anxiety had the highest odds of suicide ideation.

Conclusions

This study found a statistically significant association between being out of work and suicide ideation. The association was largely explained by self-reported stress, anxiety, socioeconomic and demographic variables.

Policy-makers within the County need to pay attention to the health status of those out of work, especially during times of combined economic and labour market fluctuations.

Key messages

Suicide ideation was more common among people out of labor force in Gävleborg County, Sweden.

Further studies are needed to investigate suicide ideation among unemployed persons during times of economic and labor market insecurity.

42. Experiences of Unemployment and Well-Being After Job Loss During Economic Recession: Results of a Qualitative Study in East Central Sweden

Hiswåls, Anne-Sofie

et al.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Sciences, Section of Public Health Sciences, Mid-Sweden University, Sweden.

Introduction: Several studies have revealed an association between unemployment and ill health, and shown that unemployment can affect people differently. This study aimed to provide an understanding of the experiences of unemployment and perceptions of wellbeing among persons who involuntary lost their work during the recent economic recession in Gävle Municipality. Methods: Sixteen unemployed men and women aged 28-62 were interviewed face-to-face. A purposeful sampling strategy was used in order to suit the research question and to increase the variation among informants. The interview texts were analysed using thematic analysis. Results: Six different themes emerged from the accounts: The respondents perceived work as the basis for belonging, and loss of work affected their social life and consumption patterns due to changes in their financial situation. They also expressed feelings of isolation, loss of self-esteem, and feelings of hopelessness, which affected their physical well-being. Longer duration of unemployment increased the respondents’ negative emotions. The respondents reported activities, structure, and affiliation in other contexts as part of their coping strategy against poor mental health. Conclusions: After job loss, the respondents experienced feelings of loss of dignity and belonging as a human being. They also felt worry, insecurity, and stress due to their changed financial situation, which in turn led to isolation and loss of self-esteem. Social support and having other activities gave the respondents structure and meaning.

Purpose of this study was to illustrate the complexity of dyslexia among university students. The method was a web-based survey, which was sent out by email to 145 students. The selection was university students, whom all had assistance granted. Results: Most respondents used extended time at the exam and audio books. The majority considered that the aid worked well, and most considered themselves sufficiently informed about available support. 60% of respondents lacked something in their support. The computer software, educational support and information from the university about assistance, are fields where improvement was sought after. Support from students who were in the same situation where something they wanted to improve. The conclusion was that the students felt that they must get more participation in the management of supporting aids. A proposal was to establish an association, were student’s whit dyslexia could be involved. In the group, students can work together to develop sustainable solutions that can be discussed with the examiners and coordinators for support. An information channel should be developed so that students who have not yet applied for support have the opportunity to do so.

The purpose of this study was to examine how individual’s experiences of well-being and routines in their daily life after participating in a health promotion intervention as a resource for return to work or studies. A qualitative method was used in this empirical study. Semi-structured interviews were used to gather data. The samples in this study was four men and two women aged 18-54 years. The interviews were documented with sound-recording and all data was transcribed verbatim and analyzed by a thematic analysis. The main result was about the experiences the individuals received from having participated in a health promotion intervention as a resource of returning to work or study. All individuals experienced increased well-being after participating in the health promotion intervention. Several of them have improved health issues, used various tools for routines and how they deal with problems and improved habits in their everyday life. The individuals have had a changed vision of the future, a sense of increased future opportunities and more involvement in their life situation. The results also showed that there were shortcomings in the health promotion intervention based on the perspective of the individuals. The conclusion that can be drawn is that the health promotion intervention was perceived as positive in terms of improved well-being, creating new effective routines and better knowledge acquisition. There were experiences of shortcomings within the intervention. Once the intervention was completed and the individuals were to maintain new habits and routines, there seemed to be some setbacks. Despite this, the intervention has reduced the ill-health of the individuals, which is significant for both society and public health. This means that the health promotion interventions and similar interventions are worth investing in to reduce the ill-health that is present in society.

AIMS AND OBJECTIVES: To explore patient perceptions of chronic obstructive pulmonary disease exacerbation and the patients' experiences of their relations with health personnel during care and treatment.

BACKGROUND: Patients suffering from acute exacerbation of chronic obstructive pulmonary disease often experience life-threatening situations and undergo noninvasive positive-pressure ventilation via bi-level positive airway pressure in a hospital setting. Theory on trust, which often overlaps with the issue of power, can shed light on patient's experiences during an acute exacerbation.

DESIGN: Narrative research design was chosen.

METHODS: Ten in-depth qualitative interviews (n = 10) were conducted with patients who had been admitted to two intensive care units in Western Norway during the autumn of 2009 and the spring of 2010. Narrative analysis and theories on trust and power were used to analyse the interviews.

RESULTS: Because of their breathlessness, the patients perceived that they were completely dependent on others during the acute phase. Some stated that they had experienced an altered perception of reality and had not understood how serious their situation was. Although the patients trusted the health personnel in helping them breathe, they also told stories about care deficiencies and situations in which they felt neglected.

CONCLUSIONS: This study shows that patients with an acute exacerbation of chronic obstructive pulmonary disease often feel wholly dependent on health personnel during the exacerbation and, as a result, experience extreme vulnerability.

RELEVANCE TO CLINICAL PRACTICE: The findings give nurses insight into building trust and a good relationship between patient and caregiver during an acute exacerbation of chronic obstructive lung disease.

We conducted a systematic review of randomised studies on the impact of worksite interventions to promote healthier food and/or physical activity among people who work irregular hours 'around the clock', that is, outside of ordinary daytime working hours. The population-intervention-comparator-outcomes-study (PICOS) design format was used. Data sources were PubMed and CINAHL. An updated search was conducted on October 2017 using Google Scholar and the related articles function in PubMed on initially included studies to identify additional studies. Risk of bias was used to assess study quality. A total of seven studies (reports published in 14 papers) were included in the systematic review: Two interventions with a broader lifestyle approach, three focusing on physical exercise and two on providing healthier food or meal options. The studies had sample sizes from 30 to 1,000 and targeted a mixture of occupations, including both male- and female-dominated occupational groups. The interventions lasted from 2 to 12 months. Only one had an extended follow-up. In general, the studies showed small-to-moderate effect sizes on several measures, including dietary and/or physical activity measures, suggesting acceptable effectiveness for interventions involving community-level behaviour change. Our findings highlight a need to further develop and implement well-designed health promotion interventions with comparable outcome measures and effect size reports. A mixture of health promotion strategies is recommended for future practice in this target population, including individually tailored programmes, improving the food and physical activity environment and using broader lifestyle approaches including the use of participatory and empowerment strategies. While more research is needed in this field, the existing knowledge base on effective approaches awaits translation into practice.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.

Gard, Gunvor

Hälsovetenskaper, Medicinska fakulteten Lunds Universitet .

Lindberg, Per

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.

Olofsson, Niclas

Region Västernorrland FoU.

Risberg, Anitha

Institutionen för Hälsovetenskap, Luleå Tekniska Universitet.

Willmer, Mikaela

University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.